Inspection on 15/01/08 for Queens Court Nursing Home

This inspection was carried out on 15th January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Queens Court Nursing Home 06/02/08

Queens Court Nursing Home 23/05/07

Queens Court Nursing Home 05/12/06

Queens Court Nursing Home 26/06/06

Queens Court Nursing Home 24/01/06

Queens Court Nursing Home 17/01/05

Queens Court Nursing Home 28/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Queens Court Nursing Home 52 - 74 Lower Queens Road Buckhurst Hill Essex IG9 6DS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vicky Dutton     Date: 1 5 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Queens Court Nursing Home 52 - 74 Lower Queens Road Buckhurst Hill Essex IG9 6DS 02085590620 02085590315 queenscourt@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ranc Care Homes Ltd Name of registered manager (if applicable) Mrs Rosemary Mathias Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 90. The registered person may provide the following categories of service: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age not falling into any other category - Code OP Dementia - Code DE Physical Disability - Code PD Date of last inspection Brief description of the care home Queens Court is a purpose built two-storey care home for up to 90 residents over the age of 65 years. The home is also registered to provide nursing care for persons aged 40 years and over, who require care by reason of a physical disability. It is located in a residential area in Buckhurst Hill near Ilford in Essex, close to local amenities, shops and public transport systems. The home is divided into four units: Two on the ground Care Homes for Older People Page 4 of 32 90 0 90 Over 65 0 90 90 care home 90 Brief description of the care home floor providing a residential care unit and a dementia care unit. The first floor accommodates people who require nursing care. Personal accommodation comprises of single rooms with en-suite toilet and wash hand basin facilities, with the exception of a shared room on each floor, also with en-suite facilities for married couples or those who wish to share. The home has a garden to the rear, a patio area to the front and ample parking. The fees are calculated according to the assessed needs of the resident and at the time of this inspection were informed that they ranged from £525.00 to £874.00. The fees are broken down into basic board and lodging fee and other costs relate to the care support and nursing provided to each individual. Additional costs include private chiropody, toiletries, newspapers, hairdressing, dial-a-ride and some activities. A service Users Guide and Statement of Purpose were not readily available to people to provide information about the home. The last inspection report was freely available in the foyer area of the home. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit. The previous inspection of the home took place on 6th February 2008. At this visit we (CSCI) considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. As Queens Court is a large home two inspectors undertook the site visit, which took place over a period of eight and a half hours. A partial tour of the premises was undertaken. Care records, staff records, medication records and other documentation was selected and various elements of these looked at to see how well these aspects of Care Homes for Older People Page 6 of 32 care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. We also spoke to several visitors during the site visit. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us. The AQAA is a self assessment docment that is required by law. It was received by the due date, was fully completed, and outlined how management feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives, involved professionals and staff. Only six surveys were returned these had mostly been wrongly completed. For example a member of staff completing a survey designed for relatives, and a relative filling in one designed for care managers. The views expressed at the site visit and in survey responses have been incorporated into this report. We were assisted at the site visit by the manager and other members of the staff team. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The main theme highlighted throughout this report is a lack of adequate staffing, or poor staff deployment. There is an urgent need for management to review the levels of care staff provided so that peoples needs are met at all times. This issue has been raised at previous inspections. Although the level of activities has improved, people still need to have greater Care Homes for Older People Page 8 of 32 opportunities for social occupation, either through care staff taking a fuller role in this aspect of care, or through the employment of more activities staff. Although the Company provides a glossy brochure to inform people about the service, people do not have access before Service Users Guide before they move in. This would provide them with a greater level of detail and potentially help in their decision making. So that the care people receive is always as safe as possible the management of medication needs to be better monitored so that the risk of any errors is minimised. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure through assessments that the home could meet their needs, but may not be certain through information available that the home would be the right place for them to live. Evidence: When people are considering moving into Queens Court they are not given a copy of the Service Users Guide which would provide them with good information about the service. A copy of the Companys glossy brochure is given to people which has an insert about Queens Court. This may not provide people with sufficient information about that specific home. The manager said that verbal information is given, and that people are encouraged to visit the home to see what it is like. One person spoken with said that they felt that they had received enough information about the home, another that I received a brochure and visited the home. A relative said that the previous manager had been extremely helpful throughout the admission process. The Annual Care Homes for Older People Page 11 of 32 Evidence: Quality Assurance Assessment (AQAA) completed by the previous manager said that a website was under development to provide people with an additional source of information. We saw that a Service Users Guide was in place, but this was not readily available for people. The Service Users Guide was in need of updating as it referred in different places to both the current manager and the previous manager. It did not include details of fees and additional charges as is now required to help peoples planning. Previous inspections had found that staff from the home assessed peoples needs before they moved in to make sure that the home would be suitable for them, and staff able to meet their needs. The manager said that it is usually themselves or the clinical nurse manager who undertakes this. We looked at the files two people who had most recently moved into Queens Court and found that good pre-admission assessments had been undertaken. There was also information available from the discharging hospital, and from the Social Services department funding the placement. We saw that when equipment had been identified as needed on admission, this was in place ensuring that peoples needs were met from the beginning of their stay. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good basic care, but this may not always be how they would like or need to be cared for. Evidence: Comments from people about the care provided at Queens Court were variable. On surveys received some time prior to the site visit comments were not always positive, but one person said that The care meets my [relatives] needs and expectations. Some people who responded felt particularly that the management of peoples continence was not good. My [relative] is incontinent, I sometimes find them with wet clothing. I feel more care could be taken to keep them clean and dry, I always ask my [relative] if they have had their pad changed before lunch. This has not always happened. At the site visit one person cared for in bed felt that they received very good care. A relative also felt that care was of a high standard and said that My relative has put on weight and come on leaps and bounds since moving in here. Other comments were less positive, such as, They do not look after my hearing aids, and do not change the batteries often enough. Without my hearing aids I cannot hear my Care Homes for Older People Page 13 of 32 Evidence: radio or television. Fifteen aids have been lost in the last three years. Often comments seemed related to staffing levels. People all said that staff were kind and caring, but did not always have time to carry out good and consistent care for people. We will look at this in greater detail under the staffing section of this report. To see how well peoples care is planned for and arranged so that staff are aware of peoples needs, and meet them in an individual way we looked seven care files. We sampled care files in each of the four units at Queens Court. The new management team at Queens Court were aware that care planning at the home did not meet peoples needs, and the Local Authority has set targets for this to be rectified. As a result of this everyones care plan is being reviewed and re-written. Staff are making good progress in this. We firstly looked at the care plans of two people who had recently moved into Queens Court to see if assessments had been translated into effective care plans. One person with a range of complex needs had moved into the home a month before the site visit. The quick reference did not identify their needs fully, and no care plans had yet been completed. Appropriate risk assessments had not been undertaken for the use of bed rails. The other person who had moved in more recently had the quick reference well completed, but only one care plan in place. If care plans are not put in place in a timely manner people may not have their needs met in an individual, planned and consistent way from the start of their stay. Other care files viewed provided a generally comprehensive picture of peoples needs that would enable staff to offer them appropriate care. However, sometimes important information was not readily apparent. A quick reference sheet is in use to provide staff with an easy to access overview of peoples individual needs. These did not always contain important information, such as equipment used at night, or mental health needs. Management therefore risk care staff not being aware of important aspects of peoples care needs, or being alert to the need to refer to the full care plan for details. One person felt that, Everyone is treated the same despite their different needs. Care plans had been regularly reviewed, and we saw that where possible people had been involved in the care planning process. Daily records of care provided were maintained. This area would benefit from development, as sometimes notes made were not person centered. Comments such as, Safety maintained, and, Medication taken well were made. Training records showed that seven staff have so far undertaken training in person centered care planning. This should help them to adopt a more individual and personal approach to care planning and recording. Records viewed showed that people access appropriate and varied healthcare professionals to meet their individual needs. This includes chiropodists, opticians and physiotherapists. Assessments are undertaken in relation to peoples healthcare needs such as tissue viability and nutrition. Care needs to be taken to ensure that assessments and ongoing monitoring are effective, and provide a joined up approach to care. For example we saw that one person had been loosing weight over a few Care Homes for Older People Page 14 of 32 Evidence: months. There was no mention of this in care planning to ensure that their eating was monitored. Nutritional assessments undertaken over the same period had maintained a constant score that indicated that the person was at low risk. Where people are cared for in bed care records such as turning and fluid charts are kept at staff work stations. We saw that records are not completed as care is given, but at the end of a shift. Staff may therefore not remember, or be accurate in their recording of events that happened during the course of a busy shift. The manager undertook to review this situation. Queens Court is registered to provide nursing care. Therefore there are always, during the day, at least two trained nurses on duty. Training records viewed did not indicate that care staff receive any training in conditions of old age or other areas that may enhance their understanding and skills when caring for very frail people. We looked at medication systems and records to see how this aspect of peoples care is managed. When we saw staff administering medication they took their time with people when giving them their medication. A number of issues were identified that showed that medication practice needs to be better monitored to ensure that people are kept safe. Medication is managed separately on each unit at Queens Court. When we looked at medication on the dementia care unit we saw that there were a number of occasions where medication had not been signed for as given. Where handwritten entries were made this had not been double signed to verify details, and reduce the risk of error. On another occasion a medication had been recorded twice on the administration record. Again this could lead to error. One person had not taken a prescribed medication on a number of days, but no explanation had been given for this. When we went around the home we saw that a medication delivery had taken place. A number of unsecured crates containing bagged and labelled medications and other items dated 09/01/09 had been left in a corridor area, not yet checked in. This could cause a potential hazard to people. Staff administering medication have received basic training. They have also recently undergone competency assessments to ensure that their practice is satisfactory. Given the above findings this may need to be looked at again. The management of controlled drugs was good. The manager was however advised to check that the storage cupboards in use are fixed to a solid wall with the correct fixings. During the day staff were observed to be respectful to people, and responsive to their needs. Privacy was maintained when personal care tasks were being carried out. Staff need to be alert to peoples needs. For example on a survey one person said that due to their relatives immobility, It is impossible to have a private conversation with her away from other residents. People should always be offered somewhere private to receive their visitors. We saw that as a way of organising staff, and ensuring residents care needs were met Care Homes for Older People Page 15 of 32 Evidence: a board contained peoples names and when they were to be assisted to the toilet. The new manager had identified that this was detrimental to peoples dignity, and was arranging an alternative scheme. When we viewed the building we saw that a number of people have phones in their own rooms. However for people who dont have their own phone, signage indicated that the pay phone is situated through a key pad coded door, so residents would not be able to use it easily or independently. The manager said that the phone is portable so could be taken anywhere for people to use. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service may have insufficient opportunities to enjoy a fulfilling lifestyle. Evidence: Queens Court had a friendly and lively feel. An activities plan was in place offering different opportunities for people. The AQAA completed by the previous manager felt that activities was an area of improvement and said, Over the last eight months we have purchased a lot of activity equipment and have also introduced a mobile shop. We have had more external entertainers and outside visits. Queens Court benefits from having an enthusiastic activities co-ordinator in post. One person said, The activities person is very good and always encourages my [relative] to join in with activities. However the home is very large and the level of need great. Although they do their best, the activity co-ordinator is unable to fulfil the activity/occupational needs of all the people living at the home without help. One person said, There is a communion service twice a month, but none of the other activities appeal to me. Observations during the site visit, and discussion with the activities co-ordinator showed that care staff are generally too busy to assist with the provision of activity, and are not yet at the stage where daily living tasks are seen as opportunities for Care Homes for Older People Page 17 of 32 Evidence: interaction and stimulation. The manager advised that the home are building up a team of volunteers who come in and assist with activities. Peoples perception about the level of activity available was varied. One person said that, There is always something going on, others that, There is no therapy or activities, There is nothing here for residents to do, and I used to go upstairs to do some crafts and painting but cannot do that now because the chairs are so uncomfortable. I enjoy music and exercises. I would like to get out more and have some fresh air but I dont know how this can be arranged. A relative said that, Staff put on music they want to hear and not what would be suitable for residents. During the site visit a music quiz took place involving sixteen residents. Of these about seven people did not participate. During the afternoon a trolley shop was taken round. A number of people are cared for in their rooms. The activity co-ordinator said that they tried to at least pop in to see these people. We saw that on the dementia care unit objects and pictures have been provided to provide interest and stimulation. We also noted that many people enjoyed having newspapers. People are able to receive visitors at any time, and family involvement is encouraged. One person on a survey said They encourage visits and want you to feel that you can pop in at any time. Visitors said, We are always made to feel welcomed and offered a cup of tea, and Staff always make us welcome when we visit. People are free to follow their own routines and we saw that many rooms were personalised to reflect residents individual preferences. Menus viewed showed that a varied range of foods are offered, and that people are able to make choices about what they eat. We saw that a hostess is employed to help manage this aspect of care. During the morning they were going round seeing what people wanted for lunch and supper that day. In discussion they had a good knowledge of peoples individual needs. We observed that they took a great deal of time and trouble to find out what people would like, encouraging them when their appetite or motivation was poor. We also saw that when people have meals in their rooms trays were very nicely laid up and presented. Since the previous inspection a new chef has been appointed. People spoken with on the day seemed generally happy with the food provided. A relative said, The food always looks good. Residents said, The food is not bad, The food is fine, and The food is good but the dining room is so noisy it makes me not want to eat. Some comments made indicate that staffing issues are impacting on this area. People said, The food is good but we do not think that staff have enough time to spend with [relative] to ensure that they eat and drink properly, and. The turnover of staff has been vast, and an over reliance on agency staff means I get given food that I have not ordered or dislike. For example I only like brown bread and generally get given white toast with marmalade which I also hate. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for safely through suitable procedures and practice being in place. Evidence: The home has a clear complaints process in place. However notices around the home advising of the procedure need to be updated, as they refer the previous manager and other personnel. On surveys people said that they were aware of how to make a complaint. Comments on surveys as to how complaints were managed reflected that concerns were always well received and listened to, but actions did not always follow through. This may however reflect the previous management at the home. We looked at complaints records and saw that seventeen complaints had been recorded since the previous inspection. We saw that complaints had been taken seriously and appeared to have been well managed. Many complaints related to staff attitude in one way or another. The new management team is working hard to address this. Two complaints had also been sent in to us (CSCI.) These have been managed through the home and the Local Authority. Training records showed us that all staff have undertaken training in safeguarding vulnerable adults. In most cases this training has been undertaken very recently. One person said Staff are all very kind, not one of them are offhand or nasty in any way. Staff spoken with understood what abuse was. One member of staff however was not clear about the need to report any concerns immediately to the person in charge. Care Homes for Older People Page 20 of 32 Evidence: Adult safeguarding procedures and contact details for adult safeguarding units were not readily available for staff to refer to. The manager advised that all staff had received their own individual copy of the procedure, but agreed to ensure that relevant information was on display and to reiterate safeguarding responsibilities with staff. Since the previous inspection a number of safeguarding referrals have been made through the Local Authority. As a result of this the home has been being closely monitored by the Local Authority under safeguarding procedures, and there have been regular monitoring meetings with the management team of the home. From observations during the site visit, some residents at the home can behave in ways that are challenging to staff. Some staff have received any training in managing challenging behaviour that may help them to manage situations better. This may benefit all staff. For example one member was clearly finding things difficult, and had put in a complaint relating to a resident being rude to them. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and pleasant home. Evidence: Queens Court is a large home that provides spacious accommodation for people. The home has recently been fully refurbished, and furnishings and fixtures were of a good quality. We noticed that some bedrooms on the residential unit had hospital style beds which did not present as homely. The manager said that these are gradually being replaced with new beds. There is an issue of inadequate storage areas around the home leaving stair landings and stair wells used for storing items of equipment. On one bathroom door there was a notice saying out of order 23/11/07 This area was on the dementia unit and also being used for storage. The area was not locked and contained items that could potentially present a hazard to those with dementia. There appeared to be sufficient equipment available to meet peoples needs. Although on a survey one person said, There is sometimes a delay in waiting for the hoist to go to the toilet. The manager said that the hoists in use are gradually being replaced so that they are reliable and continue to meet peoples needs. The call bell system in use at the home sounds throughout the home regardless of what area it is activated in. As the home is so large, and call bells are not always answered in a timely manner, there is a nearly constant unpleasant background noise throughout the building. In some areas the noise is louder than others. This noise may be unsettling or unpleasant for Care Homes for Older People Page 22 of 32 Evidence: anyone, but for people who have dementia or who may be frail or dying it might be even more so. We discussed this with the manager who agreed to look into this and see if the situation could be improved. On the day of the site visit the home was fresh and clean. There were no unpleasant odours. One person said, The home is kept very clean and well cared for. The laundry area was small for the size of the home, and there was inadequate space for the use and storage of clothes rails. These items were seen in stair areas, and in a locked cupboard which was also used for storing items relating to residents nutritional needs. This is not an ideal situation. From training information available not all staff have undertaken training in infection control to inform their practice and keep people safe. We saw that in the training programme proposed for 2009, infection control training is planned to take place during April, June and October this year. We also saw that identified staff are responsible for the management of infection control in the home. Staff in the laundry said that they had received training in infection control and other areas such as the control of hazardous substances (COSHH.) Staff said that protective clothing such as gloves and aprons were available. However they were not observed to use these as they went about their work in the laundry, and later moved around the home putting laundry away in rooms. This could potentially spread infection. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot feel confident that there will always be sufficient staff to meet their needs. Evidence: During the site visit we received much positive feedback about staff working at Queens Court. Some of the comments made were; Staff are all very kind, They are very good indeed, You only have to ask, Staff are exceptional, they are kind and nothing is too much trouble, and, The laundry staff are to be commended. They have a heavy load of washing but always manage to remain cheerful and return the washing quickly. In spite of this the one thing most people commented on was that there is insufficient staff available to adequately meet peoples needs. For example, My husband complains of having to wait a long time for help, There are never enough staff on duty in here. Usually there are periods of 15 to 20 minutes where there are no staff in the lounge, There could be more staff, All staff are good, but clearly overworked and just do the best they can. A resident on the dementia unit said, I dont like it here they rush about too much. During the site visit we saw that call bells went off for a long time before they were responded to. Staff were kind and caring, and we observed some good interactions. For example a member of the domestic team taking time to talk to a resident, who they clearly knew well, about their (residents) family. Care staff however seemed very busy throughout the day, tended Care Homes for Older People Page 24 of 32 Evidence: to be task orientated in their approach, and did not always interact with people. We saw one member of staff put bowls of porridge on the table and put plastic aprons on people without talking to them. A member of domestic staff went into a residents room putting their light on without asking them. In recent times the home has experienced many staffing issues, and has been heavily reliant on agency staff. Things do seem to be improving. The new management team have appointed a number of new staff, and are continuing to recruit. Staffing levels provided are based on an assessment of peoples needs. The assessment tool currently used to calculate someones level of need only highlights peoples physical dependency levels. So for example, when we looked at records, a resident who has dementia, is at high risk of falls, wanders and needs constant monitoring showed as low dependency. Another person who is doubly incontinent, requires two people to assist with their personal care and who has challenging behaviour, only just falls within the medium dependency category. Using this tool management risk people not being supported in the way that they need by having the correct number of staff always on duty. The manager said that this will be reviewed. When we looked at rotas we saw that they were not complete as agency/bank staff used to cover staffing shortfalls were not identified. We also saw that many staff are working two to four double shifts each week. This is not best practice as staff my become tired. All staff were however having at least one day off each week. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. At Queens Court from rotas and training information available it was ascertained that out of 49 care workers 22 have achieved an NVQ in care. We looked at the files of two members of staff who had been most recently recruited to ensure that recruitment procedures protect people living in the home. Good records were in place to show that appropriate checks such as taking up references, checking identification and employment history and carrying out Criminal Records Bureau (CRB) checks had taken place. People are therefore protected by good practice. Staff spoken with and records viewed showed that new staff undertake a good induction into the home, and ongoing training based on Skills for Care Common Induction Standards. This will help staff to understand their role and develop good practice from the start of their employment. Training records viewed showed that training is ongoing at the home. Most staff have undertaken recent training in dementia care. Care Homes for Older People Page 25 of 32 Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that management are focused on improving the home so that it is safe and well run. Evidence: A new manager has been in post at Queens Court since November 2008. They are not yet registered with us (CSCI.) The manger is experienced and very well qualified. In discussions the manager had a good awareness of individual residents and their needs. When we raised various issues during the day, the manager was able to tell us what was happening to rectify things. This showed that the manager has a very good awareness of things going on in the home. Queens Court has been through a difficult period. This inspection has shown that, although there is still a lot to do, the new management team in place is having an impact, and steadily improving the experience of people living in the home. One person said, The previous management was poor, they paid lip service to our complaints. The new management has been in place for only two months, but they seem more responsive. Care Homes for Older People Page 27 of 32 Evidence: There are opportunities for people to express their views about the home. We saw that a residents meeting is planned to take place. Staff and management meetings are held. Regular monthly visits are undertaken by a senior member of staff in the organisation to ensure that standards are being maintained. These visits include talking to people who use the service. An internal customer satisfaction survey was undertaken in August last year. The AQAA was completed by the previous manager in October last year. It was well completed and gave us all the information that we had asked for. We looked at records of peoples monies that are held by the home. We saw that people such as the hairdresser, chiropodist and newsagent only use block receipts. If individual receipts cannot be provided, then a better audit trail is needed through numbering block receipts, and then cross referencing them with peoples individual account sheets. Although we were unable to check monies on this occasion we saw from records that these are regularly audited. The manager was able to demonstrate that plans are in place to commence a proper programme of staff supervision. A timetable was in place, with a plan for all staff to be supervised at least two monthly, or more frequently as required. No major health and safety issues were noted at this inspection, but some issues were highlighted to the manager. We noticed that some doors were propped open with chairs which does not support fire safety. The manager said that a programme of fitting door guards is underway so that doors can be held open safely. Training records showed that staff had received recent training in fire safety. Although weekly tests of the alarm system take place, it was stated, and records indicated that only one fire drill per year is held. In a fire records book it recorded 05/06/08 Yearly fire drill - poor response. When we spoke to a member of staff they were unclear about what they would do should the alarms go off unexpectedly. This needs to be urgently reviewed so that all staff are clear about the homes procedures, and people are kept safe. The status of the homes fire risk assessment was unclear. The manager undertook to confirm with us that an up to date fire risk assessment that meets fire service requirements is in place. Staff training in core areas such as health and safety, moving and handling and food hygiene is ongoing. Where there are shortfalls we were able to see that further training dates are planned to address this. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 When people move into the home plans for their care based on their wishes and pre-admission assessments must be put in place in a timely manner. So that people receive care that meets their assessed needs from the beginning of their stay. 30/01/2009 2 9 13 Procedures and practice in relation to the management of medicines in the home must be monitored to ensure that they are safe and effective. So that people can bee confident that this aspect of their care needs is well managed. 30/01/2009 3 38 23 Staff must undertake 30/01/2009 adequate fire training and drills so that they react appropriately in the event of an emergency. Care Homes for Older People Page 30 of 32 Residents must feel confident that staff are trained and competent Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 8 12 Care Staff would benefit in receiving awareness training in conditions and issues relating to the care of older people. So that people have opportunities for activity and fulfilment management should review the resources available and consider appointing a second or assistant activities coordinator. This would enable a more comprehensive approach towards providing lifestyle opportunities for everyone based on their individual needs and preferences. People should be able to enjoy their meals in a pleasant and relaxed environment. Management therefore need to review the mix of peoples needs in dining areas. 3 14 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!